بررسی تغییرات هیستومورفولوژی کلیه، کبد، پانکرآس و طحال در افزایش فشار گاز دی اکسید کربنیک در طی اعمال جراحی لاپاراسکوپی در سگ

نوع مقاله : مقاله پژوهشی

چکیده

دمیده شدن ممتد یک گاز بی اثر به داخل حفره صفاقی در حین لاپاراسکوپی شرایط کاری را برای جراح راحت‌تر می‌کند. حجم این گاز باید به اندازه کافی زیاد بوده تا جراح دید کافی داشته باشد اما نباید از حد استاندارد آن (15 میلی متر جیوه) فراتر رود. متداولترین گازی که بدین منظور استفاده می‌شود دی اکسید کربن است زیرا این گاز اجازه انجام الکتروکوتری بی خطر را داده و به سرعت در عروق خونی جذب و حل می‌شود، بنابراین خطر امبولیسم گاز را کاهش می‌دهد. بیست قلاده سگ ماده از نژاد مخلوط برای این مطالعه آماده شدند. وزن متوسط آنها 3 ±20  کیلوگرم و سن متوسط آنها 2/1 ± 18 ماه بود. سگ ها به صورت تصادفی به دو گروه 10 تایی تقسیم شدند. در گروه کنترل فشار داخل شکمی در حد 12 میلی متر جیوه و در گروه آزمایش در حد 20 میلی متر جیوه نگه داشته شد. طول مت جراحی (زمان وجود گاز در حفره شکمی =4 ساعت) در نظر گرفته شد. ارزیابی هیستوپاتولوژی، تغییرات آسیب شناسی بیشتری را در کلیه تمام سگ‌های گروه آزمایش نشان داد. یافته‌های ما نشان داد ارگان هایی که رسانش خونشان توسط یک یا دو سرخرگ و بازگشت خونشان توسط یک یا دو سیاهرگ تامین می‌شود، به افزایش فشار داخل حفره بطنی بسیار حساس ترند.

کلیدواژه‌ها

عنوان مقاله [English]

Evaluation of the Histhomorphological Changes of Intraperitoneal CO2 Pressure Increase on Kidney, Pancreas, Liver and Spleen during Laparoscopic Operations in Dog

چکیده [English]

During laparoscopy, a working space is established by continuous insufflating an inert gas in the peritoneal cavity whose volume should be large enough to facilitate surgery without increasing intra-abdominal pressure (IAP) over a threshold limit (usually 15 mm Hg). The most commonly used gas is CO2, since it permits safe electrocautery and is rapidly absorbed and dissolved into blood, thus minimizing the risk of gas embolism. Twenty female mixed breed dogs which chose for an experimental procedure were prepared. Average of weight was 20 ± 3 kilograms and average recorded of age was 18 ± 1.2 months. They randomly divided to two groups (n10). In control group the intraabdominal pressure was maintained 12 mm/Hg and in test group 20 mm/Hg during the operation. Histopathologic evaluations revealed more pathological changes at the kidney of all the dogs in test group (intraabdominal pressure: 20 mm/Hg) in comparison to control group (intraabdominal pressure: 12 mm/Hg). Findings showed that, the organs with fewer numbers (1 or 2) of arteries and veins are more susceptible  to increased intra-abdominal pressure.

کلیدواژه‌ها [English]

  • : Laparoscopy
  • intraperitoneal pressure
  • CO2
  • kidney
  • liver
  • pancreas
  • spleen
 
1-    Allen, W. CH., Kazem, M. A., Dimitrios, G. H., et al (1994): Effects of Intra-Abdominal Pressure on Renal Tissue Perfusion During Laparoscopy. Journal of Endourology; 8(2): 99-103.
2-     Basim, A.R., George, A. V., Angelos, G.V.H., et al (2005): High-pressure laparoscopic entry does not adversely affect cardiopulmonary function in healthy women. Journal of Minimally Invasive Gynecology; 12, 475-479.
3-    Bassil, S., Nisolle, M., Donnez, J. (1993): Complications of endoscopic surgery in gynaecology. Gynaecological Endoscopy; 2: 199-209
4-    Blobner, M.M.D., Bogdanski, R.M.D., Kochs, E.M.D., et al (1998): Effects of Intraabdominanlly Insufflated Carbon Dioxide and Elevated Intraabdominal Pressure on Splanchnic Circulation: An Experimental Study in Pigs. Anesthesiology Journal; Volume 89 - Issue 2 - p 475–482.
5-    Caldwell, C.B., Ricotta, J.J., (1987): Changes in visceral blood flow with elevated intraabdominal pressure. Journad of Surgery research Surg Res; 43:14–20.
6-    Carrasco, M.S., Gomar, C., Jiménez, M.J., Martín, M.F., Lima, J.R. (1998): Consideraciones anestésicas en la cirugía endoscópica en humanos. In: Carrasco MS, Usón J, editors. Aprendizaje y Aplicación de la Anestesia en Cirugóa Toracoscópica. Barcelona, Spain: Edika Med; pp. 132–135.
7-    Chiu, A.W., Find all citations by this author (default).Orfilter your current search Chang, L.S., Find all citations by this author (default). Orfilter your current search Birkett, D.H., Find all citations by this author (default). Orfilter your current search Babayan, R.K., (1995): The impact of pneumoperitoneum, pneumoretroperitoneum, and gasless laparoscopy on the systemic and renal hemodynamics. Journal of the American College of Surgeons; 181(5):397-406.
 
 
 
8-Consensus Group of Laparoscopic Entry. (1999): A consensus document concerning laparoscopic entry techniques. Middlesbrough Gynaecological Endoscopy J;8:403-406.
9-    Diebel, L.N., Wilson, R.F., Dulchavsky, S.A., Saxe, J., (1992): Effects on increased intra-abdominal pressure on hepatic arterial, portal venous, and hepatic microcirculatory blood flow. Journal of Trauma; 33:279–83.
10-              Diebel, L.N., Dulchavsky, S.A., Wilson, R.F., (1992): Effect of increased intra-abdominal pressure on mesenteric arterial and intestinal mucosal blood flow. Journal of Trauma; 33:45–9.
11-              François, C., Philippe, M., Catherine, M. P.,  (2004): Perioperative management of patients with increased risk of laparoscopy-induced hepatic hypoperfusion. Swiss Med Wkly Journal; 134: 39–43.
12-              Garry, R., (1999): Towards evidence-based laparoscopic entry techniques: clinical problems and dilemmas. Gynaecological Endoscopy; 8:315-326.
13-              Greim, C.A., Broscheit, J., Kortlander, J., Roewer, N., Schulte, A.M., Esch, J., (2003):  Effects of intra-abdominal CO2-insufflation on normal and impaired myocardial function: an experimental study. Acta Anaesthesiol Scand; 47:751-760.
14-              Gutt, C.N., Oniu, T., Mehrabi, A., et al., (2004): Circulatory and respiratory complications of carbon dioxide insufflation. Digestive Surgery. J.; 21:95-105.
15-              Hung, S., Ho, M.D., Christopher, J., Saunders, M.D., Robert A., Gunther, Ph.D., Bruce, M., Wolfe, M.D., FACS, (1995): Effector of Hemodynamics during laparoscopy: CO2 Absorption or Intra-AbdominalPressure?. Journal of Surgical Research; Volume 59, Issue 4, 497–503.
16-              Ishizaki, Y., Bandai, Y., Shimomura, K., Abe, H., Ohtomo, Y., Idezuki, Y., (1993): Safe intraabdominal pressure of carbon dioxide pneumoperitoneum during laparoscopic surgery. Surgery Journal ;114:549–54.
17-              Ivankovich, A.D., Albrecht, R.F., Zahed, B., Bonnet, R.F., (1974): Cardiovascular collapse during gynecological laparoscopy. IMJ Ill Med J.; 145: 58-61.
18-              Jakimowicz, J., Stultiëns, G., Smulders, F., (1998): Laparoscopic insufflation of the abdomen reduces portal vein flow. Surgery and Endoscopy Journal.; 12:129–32.
19-              Joris, J.L., Hamoir, E.E., Hartstein, G.M., et al., (1999): Hemodynamic changes and catecholamine release during laparoscopic adrenalectomy for pheochromocytoma. Anesthesia & Analgesia Journal ; 88(1):16–21. [PubMed]
20-              Kane, M.G., Krejs, G.L., (1984): Complications of diagnostic laparoscopy in Dallas. Gastrointestinal Endoscopy; 30: 237-240.
21-              Liem, T., Applebaum, H., Herzberger, B., (1994): Hemodynamic and ventilatory effects of abdominal CO2 insufflation at various pressures in the young swine. Volume 29, Issue 8, Pages 966-969.
22-              Llagostera, P.S., Dilme, M.J., Yeste, C.M, Escudero, R.J.R, Viver, M.E., (2002): Cirugía laparoscópica del aneurisma de aorta abdominal. Angiologia Journal ; 54(3):252–258.
23-               McDermott, J.P., Regan, M.C., Page, R., Stokes, M.A., et al., (1995): Cardiorespiratory effects of laparoscopy with and without gas insufflation. Surg. Journal; 130(9): 984-8.
24-              Merlin, T.L., Hiller, J.E., Maddern, G.J., Jamieson, G.G., Brown, A.R., Kolbe, A., (2003): Systematic review of the safety and effectiveness of methods used to establish pneumoperitoneum in laparoscopic surgery. Br J Surg; 90:668-679.
25-              Molloy, D., Kaloo, P.D., Cooper, M., Nguyen, T.V., (2002):  Laparoscopic entry: a literature review and analysis of techniques and complications of primary port entry. Australian Obstet Gynaecol; 42:246-254.
26-              Motew, M., Ivankovich, A.D., Bieniarz, J., Albrecht, R.F., Zahed, B., Scommegna, A., (1973): Cardiovascular effects and acid-base and blood gas changes during laparoscopy. American Journal Obstete Gynecology; 115:1002-1012.
27-              Neudecker, J., Sauerland, S., Neugebauer, E., et al., (2002): The European Association for Endoscopic Surgery clinical practice guideline on the pneumoperitoneum for laparoscopic surgery. Surgery  and Endoscopy Journal; 16:1121-1143.
28-              Phillips, G., Garry, R., Kumar, C., Reich, H., (1999): How much gas is required for initial insufflation at laparoscopy. Gynaecological Endoscopy J.; 8:369-374.
29-              Reich, H., Ribeiro, S.C., Rasmussen, C., Rosenberg, J., Vidali, A., (1999): Highpressure trocar insertion technique. J.S.L.S. ;3:45-48.
30-              Reich, H., Rasmussen, C., Vidali, A., (1999): Peritoneal hyperdistention for trocar insertion. Gynaecological Endoscopy Journal; 8:375-377.
31-              Richter, S., Olinger, A., Hildebrandt, U., Menger, M.D., Vollmar, B., (2001): Loss of physiologic hepatic blood flow control (“hepatic arterial buffer response”) during CO2-pneumoperitoneum in the rat. Anesthesy Analgesis Journal; 93:872–7.
32-              Sato, K., Kawamura, T., Wakusawa, R., (2000): Hepatic blood flow and function in elderly patients undergoing laparoscopic cholecystectomy. Anesth Analg Journal; 90:1198–202.
33-              Schauer, P.R., Luna, J., Ghiatas, A.A., Glen, M.E., Warren, J.M., Sirinek, K.R., (1993): Pulmonary function after laparoscopic cholecystectomy. Surgery Journal; 114:389–99.
34-              Schilling, M.K., Redaelli, C., Krhenbühl, L., Signer, C., Büchler, M.W., (1997): Splanchnic microcirculatory changes during CO2 laparoscopy. Journal of Americam Journal; 184:378–82.
35-              Shulman, S.M., Chuter, T., Weissman, C., (1993): Dynamic respiratory patterns after laparoscopic cholecystectomy. Cheste Journal; 103: 1173–7.
36-              Soper, N.J., Brunt, L.M., Kerbl, K., (1994): Laparoscopic general surgery. North Englacl Journal of Medical; 330:409–19.
37-              Takagi, S., (1998): Hepatic and portal vein blood flow during carbon dioxide pneumoperitoneum for laparoscopic hepatectomy. Surgicd Endoscopy Journal; 12:427–31.
38-              Tan, M., Xu, F.F., Peng, J.S., Li, D.M., Chen, L.H., Lv, B.J., et al., (2003): Changes in the level of serum liver enzymes after laparoscopic surgery. World Journal of Gastroenterology; 9:364–7.
39-              Vilos, G.A., (2002): Laparoscopic bowel injuries: forty litigated gynaecological cases in Canada. Journal of Obstet Gynaecology Can.; 24:224-230.
40-              Vilos, G.A., Vilos, A.G., (2003): Safe laparoscopic entry guided by Veress needle CO2 insufflation pressure. Journal of Gynecology Laparoscopy.; 10:415-420.
41-              Yavuz, Y.,  Rønning, K.,  Lyng, O.,  Mårvik, R., and  Grønbech J. E., (1999): Effect of increased intraabdominal pressure on cardiac output and tissue blood flow assessed by color-labeled microspheres in the pig, Seventh International Congress of the European Association for Endoscopic Surgery (E.A.E.S.); Linz, Austria, 15,(2):149-155.
  • تاریخ دریافت: 18 مرداد 1400
  • تاریخ پذیرش: 18 مرداد 1400